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zarnon

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The ideal model is six patients an hour in which you prescribe a drug regardless what the patient came in for. There is now a pill for everything whether real or driven by TV ads inducing imaginary diagnosis. It goes so far as to provide paid vacations for doctors that prescribe medications in high enough volumes, leading directly to the opioid epidemic killing ~65,000 per year. Next opioids will be underprescribed.

The average patients per day seen in my profession, one of the busiest, is 19. Still high, but nowhere near 6 per hour.

There are plenty of diagnosis where a medication, even if available, wouldn't be appropriate. I can think of dozens of examples but antibiotics for upper respiratory infections comes as an immediate one. I spend more time talking patients out of unnecessary antibiotics than the convenience of just writing the prescription. The CDC's own guidelines call for not prescribing antibiotics in the first 7 days for uncomplicated URI in nonsmokers. Patients drive a lot of this, wanting something convenient and quick.

I don't know what world you're talking about but my interactions with pharmaceutical reps have resulted in free pens and pizza or take out Chinese. The current place I work doesn't allow them in at all. There will always be bad actors in every profession, I'm sure someone got a kickback somewhere but this widespread large scale influence peddling is long past. I make the same paycheck whether I prescribe or not. If I'm getting a BigPharma (tm) check they sure have been slow about it.

As someone in the field the last 20+ years I would put my stressors as follows:

(1) Docs are mostly employed these days and it is a tough place to be in. There's a profound loss of independence although you're the first one responsible if the proverbial crapola hits the fan. I have never had a malpractice case (humble brag alert!) but it's still always lurks in the background.

(2) Most of my difficult patient encounters take place with a small percentage of my patient panel (maybe 1-2%). However, in a system focused on pleasing people if you're not making 100% of them happy, you've got a problem. This has created a lot of stress where I want to do the right thing but feel pressure knowing the patient will probably complain if I do.

(3) Patient panels are insane. Where I work there is no limit to the amount of patients you can get on your panel. No limit! I'm in my third year at this job and still see 2 or more new patients per day. I've given up keeping track. The virtual patient care is one of the biggest burn outs of my job.

(4) The knowledge gap alluded to by Pinchaloaf is very valid. It's amazing in my field (primary care) how much this has exploded. I spend the equivalent of 1 workweek yearly in CME.

(5) Workload has been squeezed by efficiency experts to get you to bill the maximum while seeing the most patients you can per day. I'm under the gun because I insist most of my geriatric patients get 40 minute visits and it lowers my productivity. Many doctors see an excess of 20 patients per day and I can't see how you can deliver quality care like that.

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